Healthcare Provider Details

I. General information

NPI: 1023299468
Provider Name (Legal Business Name): PATRICIA JEAN MURTAUGH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19624 GOVERNORS HWY
FLOSSMOOR IL
60422-2077
US

IV. Provider business mailing address

3312 W 108TH ST
CHICAGO IL
60655-2624
US

V. Phone/Fax

Practice location:
  • Phone: 708-798-5838
  • Fax: 708-798-5865
Mailing address:
  • Phone: 773-445-0777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberPENDING
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: